Provider Demographics
NPI:1841964046
Name:HALL, JENNIFER (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:CANVAS
Mailing Address - State:WV
Mailing Address - Zip Code:26662-0420
Mailing Address - Country:US
Mailing Address - Phone:304-651-8718
Mailing Address - Fax:
Practice Address - Street 1:10003 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:CAMDEN ON GAULEY
Practice Address - State:WV
Practice Address - Zip Code:26208-7713
Practice Address - Country:US
Practice Address - Phone:304-226-5725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00943287104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker